If you were recently screened for prostate cancer and your PSA test or digital rectal exam showed abnormal results, your doctor may recommend a prostate biopsy to investigate further.
Amino found that the median network rate for a prostate biopsy is $877. Keep in mind—this is an estimate for what you and your health insurance company might pay together (combined) for the biopsy.
Read on to learn more about what a prostate biopsy is and who might need to have one.
What is a prostate biopsy?
A prostate biopsy is a procedure used to test for cancer in the prostate, a small reproductive gland that helps create sperm in men.
During a prostate biopsy, a urologist will use a needle to remove several samples of tissue from your prostate. This can be done in three ways:
Transrectal: Your doctor will insert a needle through the wall of the rectum and into your prostate to collect small tissue samples. This is a very common method.
Transurethral: Your doctor will insert a thin, lighted tube through the urethra and into your prostate to collect small tissue samples.
Transperineal: Your doctor will insert a needle through the perineum and into your prostate to collect small tissue samples.
No matter what method you and your doctor choose, you will be offered some form of anesthesia. You may have local anesthesia, which will numb the area, or general anesthesia, which will make you unconscious for the entire procedure.
After the biopsy is done, the tissue samples will be sent to pathology to look for cancer cells. Then, your doctor may request that you schedule a follow-up visit to hear your results. Before scheduling your procedure, make sure to talk to your doctor about all your options.
Who might need a prostate biopsy?
You might need a prostate biopsy if you were recently screened for prostate cancer and had abnormal results. This could include elevated PSA levels or a lump felt during a digital rectal exam.
Deciding whether or not to have a prostate biopsy can be difficult. Some men who have elevated PSA levels end up getting a biopsy that doesn’t show any cancer. This can be frustrating, since an unnecessary biopsy could still cause infection or bleeding.
If you’re not sure whether you should get a biopsy done, ask your doctor about the benefits and risks.
Are there alternatives to a prostate biopsy?
The only way to confirm whether you have prostate cancer is with a biopsy. However, your doctor may also recommend a transrectal ultrasound (TRUS).
A TRUS is done by inserting a small ultrasound probe into the rectum, which uses sound waves to produce an image of your prostate. This can help your doctor estimate the size of your prostate and look for any visible abnormalities. However, it can’t definitively confirm whether or not you have prostate cancer.
If you have an abnormal PSA test or digital rectal exam, your doctor may order a TRUS before a biopsy, or they may suggest a biopsy straightaway. Make sure to ask your doctor what’s right for you.
What determines the cost of a prostate biopsy?
Amino found that the median network rate for a prostate biopsy is $877, but costs range across the US from $407 to $2,585—a huge difference. Here are some factors that could impact how much your biopsy costs:
Where you live could affect your cost, especially since it determines which hospitals and doctors are available to you. For example, if you live in an urban area, you may have more options to choose from.
The network rate, which is what our estimates are based on, is negotiated between your health insurance company and doctor or hospital—so your insurance company and whatever provider you choose will play a large role in determining cost.
Your health insurance plan will affect your cost for a few reasons. Whether your urologist is in-network or out-of-network can impact the overall cost. Your co-insurance and co-pay, as well as how much of your deductible you have left, can also make a difference in how much you pay out-of-pocket.
What happens during the biopsy, such as what kind of anesthesia you get, can impact your cost. Although unlikely, if an emergency arises, you might have additional unexpected costs.
Your personal health also plays a role. If you have preexisting health problems, there could be additional expenses.
Now that you know how much your biopsy could cost, let’s explore insurance coverage and how to get the most care for your money.
Will health insurance cover your prostate biopsy?
Most insurers will cover your biopsy as long as it’s medically necessary. This means your insurance will cover a portion of the cost, and you will likely pay a co-pay or co-insurance (a percent of the total cost). If you haven’t hit your deductible yet for the year, you may have to pay the full cost.
If you don’t have insurance, you may have to pay the full cost of your biopsy out-of-pocket. Where you get care (which doctor and facility you go to) can have a big impact on your total cost.
How to get the most for your money
Even if your insurance does cover some or most of your prostate biopsy, you’ll likely pay a portion of the total cost out-of-pocket. To make sure you’re getting the most (and best) care for your money:
Ask your insurance company about your costs, like co-insurance, copays, and deductibles.
Utilize your Health Savings Account (HSA), Flexible Spending Account (FSA), and Health Reimbursement Account (HRA) to cover out-of-pocket expenses.
Use Amino to compare prices for different doctors.
Have a conversation with your doctor. This is especially important if you don’t have insurance and are paying for the full cost of the biopsy yourself. Some doctors will offer a discount or an interest-free payment plan if they know you’re shouldering the cost on your own.